Medicare’s physician fee schedule for 2013 contains both a 26.5% pay cut based on the Sustainable Growth Rate formula and otherwise flat payments for rheumatologists.
Dr. Charles King, a rheumatologist in Tupelo, Miss., and chair of the American College of Rheumatology’s Committee on Rheumatologic Care, said that even if the SGR formula cut is averted, the 0% change in reimbursement based on 2013 coding changes is essentially a pay cut since Medicare officials are simultaneously asking physicians to make investments in health information technology.
Dr. Charles King
"It is a salary cut by default," Dr. King said.
In more bad news for rheumatologists, the SGR formula will kick in Jan. 1 and lop one-fourth off doctors’ pay under Medicare, unless Congress steps in to halt the cut.
In issuing the fee schedule final regulation on Nov. 1, the Obama administration noted that Congress has reversed the mandated cut every year since 2003.
The administration "is committed to fixing the SGR update methodology and ensuring these payment cuts do not take effect," according to a statement. "Predictable, fiscally responsible physician payments are essential for Medicare to sustain quality and lower health care costs over the long term."
The American Medical Association decried the SGR cut.
"Eliminating this failed formula will allow us to enter a period when physicians can begin transitioning to new payment and delivery models to help meet the overall goal of improving patient care and moving to a higher performing Medicare program," Dr. Ardis D. Hoven, AMA president-elect, said in a statement.
The fee schedule final rulealso includes changes to the value-based modifier program, designed to pay physicians based on the quality of care they deliver.
In a proposed rule issued earlier this year, physicians in groups of 25 or larger would have been subject to the new pay plan in 2015. The final rule increases the size of the group to 100 initially.
Dr. King urged rheumatologists to pay close attention to the value-based modifier program since all physicians will be subject to the program by 2017, regardless of the size of their practice. He also advised physicians to begin participating in the Physician Quality Reporting System, since the Centers for Medicare and Medicaid Services (CMS) will use that program as the basis for the quality reporting in the value-based modifier program.
In the meantime, the ACR is asking CMS to slow down its implementation until there are better quality measures across a wider spectrum of conditions.
In addition, the final rule creates a new set of codes to pay physicians for care coordination in the 30 days after a patient is discharged from a hospital or nursing home. Those codes were initially proposed as G codes, but now will be full-fledged codes in the AMA Current Procedural Terminology (CPT). Physicians will be rewarded for patient interactions that are not face to face, such as phone consults, chart reviews, and email communications.
The rule was published in the Federal Register on Nov. 16, and comments will close on Dec. 31. It will take effect Jan. 1, 2013.